The Impact of Sudden Gains and Deteriorations on the Psychotherapy Process

Within the field of psychotherapy research, there has been significant evidence to suggest that people change and improve because of treatment (Lambert & Ogles, 2004). One common phenomenon that has been observed when looking more closely at outcome trajectories has been termed sudden gains/deteriorations. These are defined as sudden changes in outcome (either positive or negative) of 25% or more from the pre-change level of symptoms that are in turn sustained over time (Tang & DeRubeis, 1999). Although there are data regarding how people who experience sudden gains end up after treatment, no studies have examined the impact that sudden gains and deteriorations have more immediately on related outcome domains. The phase model of change in psychotherapy describes three sequential stages of improvement which occur over the course of successful treatment ((1) the client acquires a greater sense of well-being, (2) symptoms associated with diagnoses diminish, and (3) functioning in work, relationships, and self-care improves ) (Howard, Lueger, Maling, & Martinovich, 1993; Kopta, Owen, & Budge, 2015, p. 442). Although there is support in the research for each latter phase being contingent on the improvement of those that occur prior (Kopta, Owen, & Budge, 2015), the relationship between sudden gains and deteriorations on these various outcome domains has not been tested. The present study utilized a sample of 16,657 clients who engaged in routine psychotherapy and completed the Behavioral Health Measure-20 before every session. This measure is comprised of three scales that correspond directly with the components of the phase model (Kopta, Owen, & Budge, 2015). Among clients who experienced sudden gains or deteriorations on BHM-20 scales, multilevel piecewise analyses were used to assess if following a sudden gain or deterioration in one phase, clients experienced change in level and/or slope for the outcome associated with the subsequent phase. We found that: (1) Following a sudden gain in well-being, the mean-level for symptoms increased significantly, and the rate of change decreased significantly, (2) Following a sudden gain in symptoms, the mean-level for life functioning increased significantly, (3) Following a sudden deterioration in well-being, the mean-level and rate of change for symptoms both decreased significantly, and (4) Following a sudden deterioration in symptoms, the mean-level for life functioning decreased significantly. This series of analyses represented the first true test of the impact of sudden gains and deteriorations on clients as they continue to participate in the therapy process and of the relationships between the trajectories of change associated with the phase model

Oncoplastic breast surgery: A guide to good practice

Oncoplastic Breast Surgery has become standard of care in the management of Breast. Cancer Patents. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice

A PARADIGM OF COMMUNITY BASED EDUCATION: CASE STUDY OF THE HAVERSTRAW LEARNING CENTER OF ROCKLAND COMMUNITY COLLEGE (NEW YORK)

The focus of this study was the evolution of learning centers of community colleges that provide academic, language, and vocational education to disadvantaged communities. A synthesis of the literature identified trends in public policy that could help educational planners design programs and legislators formulate policy. As part of the State University of New York, Rockland Community College is a comprehensive two-year college open to high school graduates with consideration given to those with special needs. The Haverstraw Learning Center resulted from efforts to involve the College in the neighborhood. Subsequently, the College petitioned local representatives of the religious, social, and community agencies for input to the project. Case study techniques analyzed programs of the Center and documented the impact of public policy making on the education of the nontraditional, high risk student. The results have been traced to delivery level of services in Haverstraw. A descriptive history and chronology of the Center from its inception in Fall 1978 to Spring 1986 is given. Data from 466 students, sixty-two percent of the English as a Second Language population (ESL) served at the center, have shown the need for intervention by the college. The profile depicts an impoverished community in need of academic and vocational training. This study corroborates the belief that what operates on a national scale can be demonstrated on a much smaller one. Political thought and economic theory do affect educational policy, and can override the needs of constituents as indicated through demographic data. The Center has made a difference in the lives of its students. The importance of placing emphasis on standards is not unique; the present focus is on the methodology, time schedule, and feasibility of accomplishing quality over quantity. Despite changes in social policy, community colleges are expected to meet the needs of our pluralistic society, and to adapt to any prevailing situation. Education for the nontraditional must include substantive offerings that will equip them with the skills to be self-sufficient. Education is more than the acquisition of basics but also a preparation for leisure and personal development

Endothelial Nitric Oxide Synthase is Critical for Ischemic Remodeling, Mural Cell Recruitment, and Blood Flow Reserve

The genetic loss of endothelial-derived nitric oxide synthase (eNOS) in mice impairs vascular endothelial growth factor (VEGF) and ischemia-initiated blood flow recovery resulting in critical limb ischemia. This result may occur through impaired arteriogenesis, angiogenesis, or mobilization of stem and progenitor cells. Here, we show that after ischemic challenge, eNOS knockout mice [eNOS (-/-)] have defects in arteriogenesis and functional blood flow reserve after muscle stimulation and pericyte recruitment, but no impairment in endothelial progenitor cell recruitment. More importantly, the defects in blood flow recovery, clinical manifestations of ischemia, ischemic reserve capacity, and pericyte recruitment into the growing neovasculature can be rescued by local intramuscular delivery of an adenovirus encoding a constitutively active allele of eNOS, eNOS S1179D, but not a control virus. Collectively, our data suggest that endogenous eNOS-derived NO exerts direct effects in preserving blood flow, thereby promoting arteriogenesis, angiogenesis, and mural cell recruitment to immature angiogenic sprouts